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Tuesday, May 1, 2018

Incidentals

If we can keep a copy of a patient's insurance card on file, why can we not keep a copy of their credit card? With the use of apps for refills and reminders, why not require a patient to keep a copy of their payment on file. I'd even accept a link to a PayPal account. We should take a page from the independents who used to (and some still do) operate with a credit system.

Do you want me to order an expensive medication for you? Sure. I will bill the credit card for the copay. If you pick up the prescription, the copay is applied. If I have to return it to stock, I collect the payment for the copay which should cover my return-to-stock fees and the initial filling process. 

Think of it in terms of a hotel keeping a card on file for incidentals. "Accidentally" ordered a movie and opened the mini bar? No problem. We will bill it to the card on file.
Missed the 7 voicemails, 6 texts, 4 letters, 2 emails, and the Stripper Gram we sent to the house over the last 13 days? No problem, we will bill your copay to the card we have on file when we return the medication to stock.
Now you want your medication after we returned it to stock? Time to pay that copay ... again. I do realise we charged you already but we are actually redoing all the work. This is a separate filling of your medication. If you were to transfer your prescription to another pharmacy, they'd charge you as well.

Other "incidentals"?
1. Copays for medications returned to stock.
2. Restocking fees on special order prescriptions.
3. Restocking fees on OTC products you had us order but never returned to purchase.
4. Exceeded your limit of phone calls for the day/week asking if anything was called in yet even though you have text alerts, we promised to call you, and we have carrier pigeons on standby? Incidentals.
5. First refill request/fax to your prescriber is free. Additional requests after one week? Incidentals.
6. "Can't you just look up my insurance information?" Sure. Swipe your card right here.
7. "Can you ring out all my other stuff too?" Sure. Everyone behind you wants to wait while you check out 27 items at the pharmacy counter. Please pay the Convenience Fee to me and the Annoyance Fee to those behind you and I'd be elated to help you.
8. Yell at my techs or staff? Cha-ching, cha-ching, cha-ching.
9. Want me to try 11 different discount cards to find the best price for you? Sure thing. Just know that it costs me money to submit each claim and it costs me money to reverse each claim. For each card I process, I will charge you $1.00 ($0.50 to process and $0.50 to reverse). 

Monday, April 30, 2018

Don't Be That Pharmacist

Dear Pharmacist,
This is a note to THAT pharmacist. You know who you are. You have spent your entire career, long or short as it is, setting our profession back. You have made us the prescribers' bitch. While I have written many a post denying that moniker, it is thanks to you that I still have to argue for respect for my profession. This diatribe is for you.

Don't be an idiot.
Think for yourself.
Make your own decisions.
Life is not about doing what people have told you to do. It is about thinking for yourself and doing what you know is right.
You and I went to school. I paid someone to teach me HOW to think. When I graduated I took a test. Upon successful completion of that test, my State Board issued me a license. They told me to go forth and use my knowledge and license to make informed decisions.
Apparently you were told to go forth and question everything and to not make any decisions on your own. Apparently you were taught WHAT to think instead of HOW. Thank you again for leading to further erosion of respect for my profession.

If a prescriber writes a prescription for a Proair inhaler, am I allowed to switch to Ventolin (or vice versa)? Not exactly. However, if a patient's insurance only covers one and not the other then I am going to substitute appropriately, document the insurance requirement then, maybe, call the prescriber in the morning to inform her of the formulary change. This is how it should happen. Prescribers don't care. My state board does not care. Did the patient receive Albuterol HFA? Yes? Good. Well done. That's why you went to school and received a license from us. Pats on the back all the way around.

A prescriber asked me how to avoid all of these stupid phone calls from pharmacists asking permission to change Proair to Ventolin or vice versa. She does not care which one her patients receive. She can't keep up with the formularies. All she wants is for the patient to receive an(y) Albuterol HFA inhaler. Period. I told her to write for "Albuterol 90mcg HFA" and the pharmacist could then try Proair or Ventolin and, if not covered, switch it to the preferred without bother.

Or so I thought . . .

Until the next day when a pharmacist checked one of her prescriptions.
It was written exactly as I had instructed: "Albuterol 90mcg HFA MDI". So easy. So unmistakable. How could a pharmacist fuck it up? By leaving the following message on the rejection: "Rejecting this for you to call the doctor. Please call prescriber to clarify because there is no generic available. What do they want us to dispense?"
Are you serious?

Now remember, until yesterday when I got this prescriber to write "Albuterol MDI", if she had written "Proair" or "Ventolin" and I needed to change it, this exact same pharmacist would have sent back a message like this: "Where is the documentation that the prescriber was called? Did doctor approve the switch? No notes."

Thanks. As I already made clear: I. Don't. Have. To. I am licensed to think freely and make decisions with my license. So are you. I am legally allowed to do what I did. So are you. I told the prescriber to write "Albuterol HFA MDI" because of YOU. YOU keep calling prescribers like her and pissing them off. YOU make it seem, in their eyes, like we are incapable of making effective healthcare decisions for our patients without having our hands held and bottoms wiped by these prescribers.

I call offices about important questions and the first things they ask are: "Is it a tablets to capsules question? Proair to Ventolin?" YOU have trivialised our job so much that we can't get respect from offices, yet we wonder why they don't take us seriously when we call about REAL interactions. About real errors on prescriptions. No wonder they don't have time for us, we wasted it all calling on bullshit.

Use your brain. Use your license. Make a decision for yourself. Or come to my store and I'll show you how to be a pharmacist.
And stop disrespecting my profession.

#IfThisPissesYouOffThenItIsAboutYou

Tuesday, April 17, 2018

Your Job Does Not Matter

Once you retire, do you forget all that you were?
Do you ever stop being a pharmacist? A nurse? A lawyer? A teacher?
No. You may stop practising, but you never stop being who and what you are.
On that note, I really don't care who and what you are/were.
I don't tell my prescribers I am a pharmacist. They have a job to do and I want to listen to what they are going to tell me. Perhaps I can learn something.

CP: I see we have a counsel on this medication.
Rather Annoyed That Cynical Had Educated on Drugs: Why?
CP: It appears you prescriber changed your dose.
RATCHED: Yeah? So?
CP: So I wanted to make sure you were aware of the change. The last thin. . .
RATCHED: The other made me too tired.
CP: The last thing I want is for you to get home and have a question about why these look different. He cut the dose in half. Do you ha. . .
RATCHED: I know. I told you I asked for the change.
CP: . . . have any of the 10mg left? You could cut them in half to not waste them.
RATCHED: They're too small. I can't cut them. That's too much work.
CP: Some people like to use up what they had before. . .
RATCHED: I was a nurse for 48 years.
CP: Good for you. That doesn't matter.
RATCHED: It certainly does.
CP: Not really. I feel really bad for all the patients stuck with you over the years. You interrupt as if you know better. You can't cut tablets. You won't listen to counseling advice. You pretty much know everything. Unfortunately, you're in my world now. If you were a good nurse, you wouldn't feel the need to tell me. My mom was a nurse for 40 years. She was never a bitch to doctors or pharmacists. But please, go ahead and tell me how to do my job.
RATCHED: You're not very nice.
CP: I was always taught to treat people how they wish to be treated. You are combative and insolent and not allowing me to do my job. If you were one of your patients, how would you have handled you? Don't answer that. I'm pretty sure I'm seeing it right now. Just allow me to document our little conversation here so when you have a question or complaint, I can refer to my notes here: "Counseled the hostile witness on new strength whereupon I was informed she was a nurse for 48 years and knew more than any plebe could teach her even though new medications have come out since the Disco Era."

"Jesus, I mean, you guys do nothing but complain about how you can't stand it in this place here and you don't have the guts just to walk out? What do you think you are, for Chrissake, crazy or somethin'? Well you're not! You're not! You're no crazier than the average asshole out walkin' around on the streets and that's it."

Thursday, April 5, 2018

Practise Should Make Perfect

Something to think about: My Quote-Of-The-Week winner is phrom a prescriber.
We called to clarify an e-script that was sent.
It was wrong. Way wrong.

As soon as I introduced myself as a pharmacist, I heard:

"I have yet to write an insulin prescription correctly."

How did this prescriber know? I hadn't even given the patient name or medication. Yep. This person has prescribing privileges at an office near you.

CP: You mean to tell me that you knew before you sent this that it was wrong?
Dr. Douche Baggins: Yes.
CP: You also admitted to butchering every other e-script you write for insulin?
DDB: Pretty much. Yep.
CP: Do you have a phone? You know, one that makes calls as well as receives them?
DDB: Yes.
CP Have you ever, and I know this is a wildly ridiculous and revolutionary concept, perhaps considered, I don't know, maybe calling in the prescription to the pharmacy? I'm just spitballing here but it could just work.
DDB: But I have to send it electronically.
CP: Right. Here's how it would work. You would call me, CP, The Almighty Drug Tsar, and I would walk you through HOW to write the prescription. You're good. I'm good. Patient not dead. Everybody wins.
DDB: <brain implodes> I don't know how to do that.
CP: Alternative option #2, and it's as wild as the first option, Call your software provider and ask for more training. You are already paying them for their services, you may as well make use of them.
DDB: But then I'd have to learn something. I learned everything I need to know in Medical School. Nothing changes after Med School. The world stays the same. My mommy and professors told me so.
CP: And that's why they call it a practise. Unfortunately at this rate, you'll never get it right.

#ThankYourPharmacist
#WhyIHateEScripts
#WhyYourPrescriptionTakesSoLong
#WhyYourPharmacistHatesYourDoctor